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Cataract Surgery:Complications during Surgery

Due to the
advances in technology and surgical techniques, the success rate of cataract
surgery is now very high in many centers. That means that nothing can go wrong,
can it? So many people now have had successful cataract operations, and some are now talking about cataract surgery as being only a 'minor' procedure. Doesn't this mean that complications during surgery are a thing of the past?

No, it does not. Complications still can, and do, happen even in the most experienced of surgical hands!

(Image adapted from the internet)

Cataract surgery is the removal of the cataract and its replacement with a lens implant.

But don't worry.
It is common to have some discomfort, grittiness, sensation of something in the
eye, and blood on the surface of the eye after surgery. More serious complications are uncommon and occur in only around 3% of cases. The great majority of problems are
mild and will clear up over a few days to a few weeks without treatment, or are
easily treated without long term consequences.
Occasionally, a second operation will be needed to fix problems from the
cataract operation. Severe complications resulting in
blindness are very rare (less than 0.1%).

Complications
can occur during surgery itself, within a few days/weeks of surgery, or months
after surgery. Often, these complications occur not because of anything
you have or have not done. If at any point, you are concerned that you may have
developed complications following cataract surgery, please consult your
ophthalmologist without delay. It is better to be safe and get your eye
examined. Your ophthalmologist would also prefer the reassurance that your eye
has not run into any problems, so please do not worry about 'wasting' your
ophthalmologist's time.

PROBLEMS DURING CATARACT SURGERY

Injury to the
iris: Less than 10% of people have an injury to the iris (colored part of
the eye). You may notice a discoloration or irregular shape of the iris or even
stitches in the eye (occasionally sutures have to be put in for iris injury).
This does not usually cause any problems later on.

Iris trauma during cataract surgery may result in an irregularly shaped pupil. It can look quite alarming at first glance. Although generally harmless, it may cause mild symptoms such as glare in bright sunlight.

(Image adapted from the internet)

Piece of lens
left behind: A bit of the lens with the cataract can break off
and become lost in the eye. This happens in fewer than 10% of operations, and is
usually harmless. The lens fragment often slowly degrades away without causing
any after effects. However, if the piece of lens is large, you may need another
operation to remove it.

Retained lens fragments in the eye usually do not result in any clinical consequences. However, surgical removal may be needed if the fragment is too large or causes persistent ocular inflammation.

(Image adapted from the internet)

Damaged capsule (posterior capsule rupture): The capsule is the bag that supports the lens inside your eye. It is an
extremely thin structure. Just how thin is it? Try to imagine the thin
film between the layers of an onion - the capsule is even thinner than that!
Because of how flimsy the capsule can be, it can tear or break during cataract
surgery. This happens in 2% to 3% of operations. In most cases, the problem
can be managed during the surgery itself. However, sometimes, a second operation
is needed to fix problems that occur from this complication, such as retinal detachment and glaucoma.

Posterior capsule rupture is a complication that most ophthalmologists dread. If not managed properly, it may lead to complications such as glaucoma, persistent uveitis, cystoid macular edema, retinal detachment and infection.

(Image adapted from the internet)

Bleeding: It is relatively
common to have a little bleeding or oozing (subconjunctival hemorrhage)
around the eye during surgery. Heavy bleeding inside the eye (suprachoroidal
hemorrhage), however, is completely different. It is a
serious condition and may cause permanent visual loss. It is not common, and occurs in less than
0.1% of the time. This happens when a large blood vessel between the choroid
and sclera ruptures, causing a major bleed behind the eye. When there is a suspicion of suprachoroidal
hemorrhage, the best thing your ophthalmologist can do is to stop the operation
immediately and close up the wounds. The operation can be resumed after a week
once the hemorrhage has settled. Continuing the surgery in these circumstances
would be exceedingly risky, and so it's definitely better to be safe than sorry.

(Image adapted from the internet)

While subconjunctival hemorrhage after cataract surgery may look serious and unsightly, the blood is located superficially under the conjunctiva and is of no clinical consequence.